Echoes of Liver in the Lung: A Diagnostic Zebra in Thoracic Oncology

Hepatoid adenocarcinoma (HAC) is a rare and aggressive subtype of extrahepatic adenocarcinoma that mimics hepatocellular carcinoma. Pulmonary HAC is exceptionally uncommon and often presents diagnostic and therapeutic challenges. We describe a 65-year-old woman with chronic obstructive pulmonary disease and hypertension who presented with progressive dyspnea. Imaging revealed right lung masses and mediastinal lymphadenopathy. Biopsy confirmed hepatoid non–small cell lung cancer. Molecular testing revealed no actionable mutations. The patient declined systemic therapy. This case highlights the complexity of managing pulmonary HAC, the role of shared decision making, and the urgent need for more evidence-based treatment approaches.